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Now, will each member of the family please The affection often runs a long time without read this, and then go to his desk and write being suspected by the practician. A too us something of working value ?
common fault of the profession, especially if
the patient be a lady, is the prescribing of Efficient Disinfection. Disinfection is only efficient when complete;
suppositories or ointments, without having
made an examination. like antisepsis, it is valueless if any detail of defecation is caused quite as frequently by fis
Pain during and after technic be omitted. If death occur in a case
sure as by hemorrhoids, and local applications of virulently contagious disease, the room is
made in the ordinary manner, are worse than generally disinfected; but attendants and body useless in fissure. Always insist on examinaare often allowed to escape. This is a flaw in
tion when a smarting or burning pain is comthe method which makes it a question whether plained of, during and for a time after every any actual good has been done. To make
bowel motion. Use the speculum in examinamatters actually safe, it is wise to insist upon
tion; the fissure generally lies deep in the thoro disinfection of the room, of the body, of
sulcus of the anal mucous membrane, and is not the attendants, and their clothing; and tho the
visible until the parts are put on the stretch. patient be living, of the body also.
When the fissure is located, sponge it clean Clothing is best disinfected by immersing in
with pure peroxid of hydrogen, and apply full water in the room ; it may then be sately carried to wherever it is most convenient to boil,
strength ichthyol the entire length of the fis
sure. Allow speculum to remain in position steam, or treat by chemical disinfectants.
for several minutes, and on withdrawing it do Carbolic acid is perhaps the best and cheapest
so in such a manner that the application will all around disinfectant.
not be disturbed. Repeat every second or The room cannot be satisfactorily disinfected
third day until the fissure heals. while occupied by a living patient. If the
Or, after cleansing, apply the following ointpatient can be moved, the room may be disinfected, and the patient returned. Otherwise it
ment thru the speculum : Iodoform, i dram;
belladonna ointment, 72 an ounce; carbolic is advisable to await recovery or death. After
acid, 10 gr.; vaseline, 2 an ounce. Use once completion of the case, all our readers know
daily. the proper use of sulfur and formaldehyde, of
Or, after cleansing, apply a solution of carbolic acid and corrosiv sublimate.
cocain, about 6 grains to the ounce, to obtund Disinfection of the living patient and of the
sensibility. Then apply nitrate of silver, 15 attendants is quite important. An infected
grains to the ounce. patient is disinfected by a bath of corrosiv
Or, if the practician have no speculum, he sublimate or carbolic acid, and a complete
may ameliorate the condition by the insertion change of clothes and bedding. Corrosiv sub
of an iodoform suppository containing 10 limate is only to be employed where a porce- grains of the drug, half an hour before the lain lined bath tub is available. The disin
expected movement and immediately afterfection of the patient improves his comfort and
wards. safety, and it protects, in a measure, those who attend him. After the first thoro bath and dis- Uncinariasis, or Hook Worm Disease. infection, it is often advisable to employ anti
There is a plague developing in the United septic sponging at frequent intervals. The
States, particularly in the Southern States, attendants should subject themselves to the
which is destined to work great harm. It is same method and subsequent precautions.
but indifferently understood by the mass of If an exposed person will submit to such
practicians, and errors of diagnosis are comtreatment, and don a complete change of cloth
mon. The widespread ignorance regarding ing, he may be released from quarantine, but
this parasite is all the more deplorable, because must be kept under supervision. Naturally he
we have a common drug which seems to act as must remain away from possibility of reinfection until the known period of incubation is passed
a specific in this affection, seldom more than
two courses of medicin being required. Even safely.
so erudite an authority as- Tyson says: “The Treatment of Anal Fissure without Radical habitat of the worm is the duodenum and upOperation.
per jejunum of man and certain anthropoThe majority of patients suffering with anal morphous apes, it is said, thruout the inhabited fissure object to operation, and will try any globe; but beyond some apocryphal descripother treatment offered them before yielding tions by physicians of the South American to operativ procedures. Despite the fact that States, it is unknown here." Braun also says: the text-books universally advocate operation “It is sporadic only in the colder countries, as the only cure, many cases are curable, if being more prevalent in southern latitudes, careful attention is paid to them.
especially those of Italy and Poland ; in fact, it has been largely spread by laborers from noted peculiar markings on the tongue, dethese countries thruout Germany and Austria- scribed as if “ streakt with dark blue ink.” Hungary, the West Indies and Brazil, the St. Others have claimed “ground itch” as an Gothard tunnel being one of the localities in initial symptom, but this is not definitly estabwhich it was first studied.'
lisht as yet. It is quite possible that where inWithout doubt in our Southern States it is fection occurred thru the sole of the foot that endemic, since it is being repeatedly reported this would be one of the earliest symptoms. from remote sections where foreigners do not The diagnosis is made by finding the eggs or penetrate, and where the inhabitants do not worm in the stool; by blood examination to migrate. This view is supported by the fact, detect the accompanying eosinophilia; and by that all authorities admit, that eggs of the worm the severe anemia and weakness without other are common in earth, and that “dirt eating discoverable cause. is common in certain sections of the South The prognosis depends upon the duration of where these cases have been reported. Dr. the attack and the numbers of the parasite Allen Smith, of the University of Texas, has present in the intestin. done much to attract the attention of the pro- The treatment most approved is that by fession to this insidious menace. Since the thymol. Precede treatment by a twenty-four eggs are only hatcht after expulsion of the feces hours' fast. Give thirty grains of thymol at 8 from the body of the host, it is fairly presum- o'clock a.m., and at 8 o'clock p.m., and folable that they may be disseminated thruout a low the second dose a little later with a purgalimited area by means of wind and water. It tiv dose of castor oil or magnesia. If the first is now establisht that infection may occur effort is not successful, the treatment may be from eating food contaminated with the eggs, repeated in the course of a week. All the or by external contact, thru the skin-Professor classical treatment for anemia is indicated. In Loos, of the University of Cairo, becoming ac- Germany, the preparations of male fern are the cidentally infected thru placing a culture on most popular medicaments in this affection, but the back of his hand. The same observer much better results appear to follow the use of smeared cultures on the skin of a dog, without thymol in this country. Prophylaxis is secured friction or scarification; the dog showed completely by proper care in food and water symptoms of the disease later, and the post- ingested, and avoiding too much contact of the mortem examination showed typical lesions skin with infected earth, as by going bareand the presence of the parasite in the internal footed. organs.
We hope that the interest of the profession This worm is found as male and female; the will be aroused in regard to this parasite before male is about one-third of an inch long, with a great areas of our country become contambulbous expansion at the tail end; the female inated. Proper and repeated examinations has about the same contour, and is one-third to will detect the disease in those afflicted, and two thirds of an inch in length; both sexes are the excreta from such patients should be as amply provided with hook-like teeth, with carefully disinfected as in any other transwhich they attach themselves to the mucosa of missible disease. The ignorant habit of dirt the intestin. They live by sucking the blood eating should be constantly assailed in sections from their host. The female deposits immense where it is prevalent. It is not impossible that quantities of eggs, which are demonstrable in failure on the part of the profession to heed the the feces by the microscope. The eggs are but warning may result in widespread infection ; 0.002 inch long, and 0.0012 inch broad, sup- the North is by no means beyond the danger plied with a transparent shell, and deposited in
line. a state of segmentation. They require both air and moisture to admit of hatching, and the
Caustics for Small Skin Cancers. process consumes but twenty-four hours. It Stelwagon notes the fact that caustics are takes about six weeks for the larvae to mature. often preferable in the removal of small skin
The first noticeable symptom in a patient in- cancers. Outlying pathological cells are often vaded by this parasite is anemia, often of se- missed by the knife, and recurrence is prompt. vere type; it may develop slowly or rapidly. By use of caustic, such cells are weakened or Colicky pains, small hemorrhages, and diarrhea destroyed, and reappearance is less likely. A follow in varying types of severity. Extreme patient will often submit to the use of caustic, weakness and indisposition for either mental or early in the disease, and when the operation is physical effort follow in severe and chronic but a slight affair ; where, were the knife sugcases. Hypertrophy and dilatation of the gested, treatment would be postponed. There heart have been noted in numerous cases. is no danger from the proper use of caustics; When occurring in children the sexual organs it is temporizing with mild caustics, or timid develop indifferently. Some observers have use of activ caustics, which may be harmful.
Such agents as silver nitrate are useless. The clusion of many cases of miliary tuberculosis. author is satisfied with four agents : arsenious It would matter little if one did treat a case of acid, caustic potash, zinc chlorid, and pyro- acute miliary tuberculosis as one of typhoid gallol. As an adjuvant and additional medic- fever, but it would be a serious error to treat a ament he uses 5 to 10 percent salicylic acid. case of typhoid in a tuberculous jatient as a Arsenious acid, if not too long in contact with case of acute miliary tuberculosis.
The episthe skin, has a selectiv action against the path taxis, gradual rise of temperature, absence of ological cells, and but little action against facial paralysis, the presence of an eruptiin, healthy tissue. In small lesions there is but and the Widal reaction should separate most little difference which agent is employed ; in cases of typhoid fever. There are more points large cancers pyrogallol is preferred on ac. of difference in the two diseases than one count of its painless action, but it must be might think. Stevens (Practice of Medicin) remembered that it is one of the weakest of gives the following admirable table of differenthe activ caustics. It is used in vaseline or tial diagnosis : resin cerate, 25 to 3373 percent strength, and it takes ten days to three weeks to get satis
Acute miliary tuberculosis. factory results, and may require repetition in that time. It is spread on lint or leather to a Epistaxis common.
Temperature thickness of 78 to 14 inch, and fastened in
rises gradually. Temperature rises abrupuy, and
and runs a regular course. runs an irregular course. place with bandage or adhesiv strips. The Diarrhea is common.
Seldom noted, except in abdomapplication is renewed every 24 hours. At An eruption generally present. Only rarely observed. each dressing, the sluf is gently removed, and
No tubercles on retina.
Respirations still more hurried. the ointment reapplied. After all sluf has Facial palsy rare.
Never give a diagnosis of typhoid fever in a Acute Miliary Tuberculosis.
tuberculous family until the range of temperaThis disease baffles the most skilled diagnos
ture has been watcht for several days, and if ticians. It is indeed rare that a case is diag. possible delay it until time for the eruption to nosed. Occasionally a tuberculous history or
appear. If we were more exact in our examithe accidental detection of tubercles on the
nations and study of cases, it is likely that we retina may arouse suspicions of the existence
would more often suspect cases of acute miliary of the disease. It is often secondary to pre
tuberculosis, even tho we might not be able to viously existing pulmonary tuberculosis, local
verify the diagnosis ante mortem. tubercular troubles, or “scrofulous glands ;'' but many times appears suddenly without evi- Is the Speculation Fever Coming Again ? dence of earlier infection. It closely resembles Do you receive many circulars and other typhoid fever in evening rise and morning fall literature concerning mining and other specuof temperature, debility, emaciation, brown lativ schemes these days? I do. They call and fissured tongue, weak pulse, enlarged spleen,
them “investments," specially adapted to stupor, delirium, and subsultus tendinum. There 6 small investors." Yes, they are - investmay or may not be cough. Bacilli are rarely ments" for the other fellow's benefit, not found, even if the sputum be searcht. The yours. You send your money, and it becomes duration is 14 to 30 days, and the prognosis is an “investment vi for the other fellow, not uniformly fatal.
you. He has caught his sucker, and your It may affect the lungs, in which event we money is his reward. Yes, it is “specially have dyspnea, cough, muco-purulent and bloody adapted to small investors." They can't hire expectoration, cyanosis, abundant and varied experts and make investigations like capitalists rales, and perhaps bronchial breathing. It may
can. The schemers, by making glowing prombe confused with pneumonia. If the meninges ises, set out to catch small investors, as docbe affected, there is intense headache, with tors, school teachers, preachers, etc., and as convulsiv attacks, facial paralysis, photophobia, many a mickle make a muckle," they come delirium, and Cheyne-Stokes' breathing. This out as well as tho they had caught a few big form is often confused with other nontubercular
fish-with this difference: The big ones are forms of meningitis. If the intestin and peri. hard to catch, while the little ones are easy toneum be involved, we have one of the hardest to catch. Hence they set their nets for the of diagnoses presented for solution; for here little ones—the small investors. we have the delusiv symptoms of abdominal THE MEDICAL WORLD put a pretty thoro tympanites, diarrhea, pain, and tenderness. stop to this sort of thing in the medical pro
It is an undisputed fact that the mortality fession a couple of years ago, and saved to the records of typhoid fever are increast by the in- profession doubtless hundreds of thousands of dollars; but lessons are sometimes forgotten. are interested in. After seeing the advertiseWhen a man who is not accustomed to having ment prepared from this point of view, I added surplus money gets little ahead, he falls an the note that appears at the bottom of page easy prey to those who want to transfer that 141, first column, but the editorial was not surplus to their own pockets, and their glowing seen by any one connected with the thermol promises make safe and sensible investments establishment until after the issue was printed seem tame in comparison. The small in- and mailed. The advertisement appears, where vestor's” head is easily swollen. He dreams advertisements appropriately appear, in the adof great profits-and finally awakes to the vertising pages—in this instance the first page stern reality that his money has gonè, never to and a half following pure reading matter, num. return. Sometimes he will make a bad matter bered 19 and 20.
The editor of Critic and worse by “sending good money after bad." Guide seems to be an enemy to American Then let him think how comforting it would chemicals, and very favorable to foreign chembe if his money were safely invested, with icals. I welcome chemical and therapeutic good security—say a mortgage—and drawing advances from all sources, but all things being only a moderate interest. All this should be equal, I am naturally (patriotically) more thought of before you part with your money. favorable to those of American origin than I am writing this in May (13th), and thinking those of foreign origin. Yet if I would favor of the thousands of doctors in all parts of the thermol or any other American chemical in country, who have gone thru a winter of hard my reading columns as much and as constantly work. May is usually a hea 'thy month, and as the Critic and Guide, and in fact nearly the tired doctor has a chance to rest. Also, every other medical publication favors foreign this is the time to straighten up all accounts chemicals, Critic and Guide would cry for your hard winter's work and make collec- "interested motivs." Critic and Guide is entions; and if you can't get the money, take tirely responsible for this reference to thermol, notes. And if you are so fortunate as to get and if he wishes to keep it up, I can too—to in a surplus of money, think of the above. the advantage of what I am convinced is a Keep your money safely in bank till you are worthy American chemical-practically a comconvinced of the proper and safe thing to do bination of aspirin and phenacetin, with the with it.
virtues of both, and the disadvantages of
neither. I will here venture to express a True Chemicals of American Origin.
thought that has frequently occurred to me, There is a man in New York City who calls but I have never put it into words before. Dr. himself Doctor “Wm. J. Robinson.” A year Summers is a chemist. He has created this or two ago he started a bright little journal for and other worthy and useful chemicals. Being doctors and druggists called “ The Medico- a chemist and not a commercial man, he has Pharmaceutical Critic and Guide."
not succeeded in giving these remedies the attracted to the paper and liked it, because it kind of a start that they deserve. Mr. Frank seemed to be fearless and honest. In the May Ruf took an acetanilid mixture, called it antiissue, page 135, he accuses me of “ advertising kamnia, and by push, enterprise and commerthermol in my editorial pages. He evidently cial talent of the most efficient order, made a refers to pages 138 to 141, April WORLD. fortune out of it. I would like to see a combiPlease turn to these pages and read, and see if nation between him and Dr. Summers.
Mr. you think this charge is true. I feared that it Ruf could then doubtless make another formight be a too severe condemnation of the tune, and at the same time advance the cause coaltar analgesics in general to suit the ther- of true American chemicals (not mechanical mol people, and so it seems, for almost im- mixtures), and also serve the true and lasting mediately after the appearance of the April interests of the medical profession. Then he WORLD I received a polite letter from the would have remedies that he would be proud Organic Chemical Manufacturing Co. (the to tell the profession all about, and his busithermol people) withdrawing their advertise- ness would be permanent; for being true chemment from The MEDICAL WORLD. That is icals, druggists and doctors could not make all right. I exprest my true sentiment, and I them for themselves, by merely making a mix. don't withhold nor disguise my true sentiment ture in a mortar. No charge for this suggesfor any advertisement or other consideration. tion, gentlemen! Hope it will benefit you Possibly my feelings have been somewhat ex- both. treme toward these analgesics, as proven by their large and extensiv use. I urged the thermol
Dr. Carter, Liverpool Med. et Chir. Jour., advises
the use of mercuric chlorid in doses of 1-1,000 of a people to get up their advertisement from a grain every hour for twelve doses, in vomiting and clinical instead of a chemical point of view, as gastro-intestinal fermentation. He has not found
larger doses necessary, and believes the remedy a it is the clinical value of a drug that doctors valuable one in such conditions.
ORIGINAL COMMUNICATIONS tom noticeable in chickenpox; yet it usually
follows other symptoms. Short articles of practical help to the profession are solicited for
The pain in the head and back is more this department,
severe in smallpox. Osler says that in no Articles accepted must be contributed to this journal only. The other disease is the pain in the head and back editors are not responsible for views expressed by contributors.
so severe as in smallpox. In severe cases there Copy must be received on or before the twelfth of the month, for publication in the issue for the next month. We decline
is pain in the epigastrium, and vomiting. responsibility for the safety of unused manuscript. It can
The eruption is very distinctiv. In chickenusually be returned if request and postage for return are
received with manuscript ; but we cannot agree to always do so. pox it appears by the second day; first on Cortainly it is excellent discipline for an author to feel that he must chest, spreads to neck, face, forehead, trunk,
say all he has to say in the fewest possible words, or his reader is sure to skip them, and in the plainest possible words, or hús
and limbs, in order mentioned, rapidly changreader will certainly misunderstand them. Generally, also, a downrighi fact may be told in a plain way; and we want
ing from macules, to papules, vesicles, and downright facts at present more than anything else.-RUSKIN. sometimes pustules, coming out in successiv READ REFLECT COMPARE RECORD crops, so that all stages may be seen on a
small area at the same time. The fever reSmallpox or Chickenpox ?
mains about 100° to 101° thruout the erup
tion, which usually lasts three to six days. Editor MEDICAL WORLD :—With reference
In smallpox the patient is taken with chill, to the above query there is a little point often
or chilly sensations, fever, pain in head, back, overlookt in making a diagnosis. In chicken
and limbs--very much like la grippe symppox the vesicle is unilocular; hence if prickt
toms, which rer. in about the same until the with a needle at one point, it will immediately
fourth day, when the eruption appears as collapse. Per contra, in smallpox the vesicle
or macules, on forehead. If is multilocular, and must be prickt thru and
examined at this time, the “shotty" bodies thru in various directions before it will totally
can be felt, deep under the skin. The temcollapse. A couple of years ago I had several cases of establisht, appetite returns, and patient feels
perature begins to decline, secretions are rechickenpox in my practise, two of which, an
better for three or four days, during which adult and child, were covered from head to
time macules change to papules, and these to foot with the vesicles; so much so that had the
vesicles, when the secondary fever puts in source not been definitly known (also that two other children had the normal disease from
its appearance, and is usually in proportion to
the severity of the disease, and ranges from the same source), it is highly probable that these two would have been diagnosed smallpox.
2° to 6° or 7°. The appetite is lost, tongue In both, too, the back and general aching was
heavily coated, urin scanty, conjunctivae con
gested, and in severe cases the eruption may most intense. ARTHUR E. GRESHAM, M.D.
be felt in the mouth. The vesicles range in Sierra Madre, Cal.
size from small shot to a bullet, and each one
is located on a red, indurated base. The Differential Diagnosis Between Smallpox contents cannot be evacuated by one puncture, and Chickenpox, and Between Smali- but must be punctured several times before pox and Pemphigus.
the fluid will all escape--a point very diagnosDEAR EDITOR:- I read with interest Dr. tic of smallpox. The vesicles soon become Groom's article, page 158, April WORLD, pustules, which soon rupture and dry up, asking diagnosis for an epidemic eruption, forming a crust, which soon drops off, leaving and ye Editor's comments.
a red surface. Typical cases of smallpox and chickenpox With these points in mind, a differential can be easily differentiated. But atypical diagnosis can usually be made. cases of either disease may present symptoms, My opinion is, Dr. Groom's diagnosis is or an absence of symptoms, that may make a correct; that he was dealing with an epidemic diagnosis difficult. However, there are certain of smallpox, in light form. landmarks with each disease which will usually I was also interested in article by Dr. Ross, serve to distinguish one from the other.
page 197, May WORLD. We have had an epiSmallpox attacks all ages alike, while chick- demic of pemphigus during the past winter. enpox, according to best authorities, is pre- It was confined mostly to children. Some few eminently a disease of childhood.
adults affected. Vaccination influences smallpox, but does Authorities differ in their description of the not affect chickenpox.
disease. One writer mentions ninety-seven Invasion of the two diseases presents about varieties, If that is true, I cannot claim the same symptoms, except that smallpox is acquaintance with all of them. However,
they are agreed that pemphigus is a skin affecSometimes the eruption is the first symp- tion, and does not necessarily produce consti